The need for stronger behavioral health policies and systems is essential to combat record-breaking overdose deaths and increasing mental health challenges. Recognizing that the justice system has become a default mental health provider, policymakers seek ways to improve health care continuity as people leave prison and jail, including allowing Medicaid to cover services before release. Federal law prohibits Medicaid from covering most health care for prisoners. Long-term Medicaid coverage has the potential to improve behavioral health outcomes and decrease the odds of rebooking individuals back into jail, according to The Commonwealth Fund. With bipartisan support, new approaches have advanced at the federal and state levels. Proposals to amend Medicaid’s longstanding inmate exclusion have advanced along two pathways: federal legislation and Medicaid waivers. The Medicaid Reentry Act, part of proposed federal legislation, would allow Medicaid to cover health care services in the 30 days preceding release from prison or jail. Waivers to the federal government already submitted by nine states would modify (or waive entirely Medicaid’s inmate exclusion to allow for coverage of certain health services provided to inmates pre-release.
Making these reentry policies a reality will require bridging gaps between the health and criminal justice systems. The Health and Reentry Project (HARP) convened government officials, key stakeholders, and people who have been incarcerated. Strong support was expressed for efforts to allow Medicaid to cover pre-release services, which they believe will improve continuity of care and equity, and support people in successfully returning to communities. They agreed on a “north star” reentry health care model that helps people return to communities “healthy and whole.” The model includes enhanced primary care that facilitates access to mental health and substance abuse treatment, trust between patients and providers, service coordination and navigation to support reentry, and trauma-informed care to help mitigate the effect of past trauma.